WHO and NIMH are proposing a collaborative cross-cultural study of psychosocial determinants influencing course and outcome of severe mental disorders, especially schizophrenia. This program would be a replication and successor to the International Pilot Study of Schizophrenia (IPSS). The US Field Research Center will be administratively based in the Clinical Research Branch, NIMH. This grant application is intended to facilitate development of methods and data collection during a pilot phase from July 1977 to December 1979. To obtain access to representative study populations, research settings in Rochester and Hawaii are proposed to carry out the US role in the WHO program. Three principal components of the study are: (1) Study of Patients and Members of Their Families with Stand Diagnostic Instruments: With extensive experience in the IPSS and with trained interviewers available in Rochester, Dr. Wynne can readily continue the reliable use of the diagnostic instruments which will be used in other WHO Centers. (2) Development of Family Assessment Methods for Cross-Cultural Use: Collaboratively with Dr. Katz, Dr. Wynne and his Rochester colleagues would adapt family assessment methods for use in other Centers and try out methods suggested by other Centers with a Rochester pilot sample of families. (3) Sociocultural Study of the Catchment Area: Monroe County, including and surrouding Rochester, has resources unique in the US for study of the demographic characteristics of essentially all psychiatric patients through the Cumulative Psychiatric Register, in operation since 1960. Information from this Register can be linked with a cancer register, a pregnancy register, and a mortality register (with information about deaths from all causes). The ethnic and social class characteristics of the 50 census tracts of the county are well documented. After initial planning and trials by the Rochester and Hawaii centers, sharing of methods with the WHO Center in Japan, and then with the other countries in the nine-country WHO network, will follow.